Fetal Echocardiography Findings and Postnatal Outcomes: Are There Significant Changes?

Objectives: This study aimed to determine the accuracy and concordance rates of prenatal and postnatal diagnoses in cases evaluated with fetal echocardiography (FE) during pregnancy and transthoracic echocardiography (TTE) in the postnatal period. Methods: Data from 163 cases referred for FE to the Pediatric Cardiology Clinic between December 2017 and December 2024, and subsequently evaluated with postnatal TTE, were retrospectively analyzed. Demographic characteristics, indications for FE, prenatal and postnatal diagnoses, and diagnostic concordance rates were examined. Diagnostic agreement was assessed using the Kappa statistic. Results: The overall concordance rate between prenatal and postnatal echocardiographic diagnoses was 91.41%. The sensitivity of prenatal diagnoses was 86.36%, specificity 94.85%, positive predictive value 91.94%, and negative predictive value 91.09%. A diagnostic concordance rate of 100% was achieved for major congenital heart diseases (CHD) such as tetralogy of Fallot, transposition of the great arteries, hypoplastic left heart syndrome, double outlet right ventricle, and complete atrioventricular septal defect. In contrast, lower prenatal detection rates were observed for lesions such as atrial septal defect and partial anomalous pulmonary venous drainage. In addition, some complex anomalies, including aortic arch hypoplasia, demonstrated reduced diagnostic concordance. Conclusion: Prenatal echocardiography provides high accuracy and agreement in the early diagnosis of major CHD. However, diagnostic limitations persist in small defects and complex lesions. Systematic comparison of prenatal and postnatal echocardiographic findings is essential to enhance diagnostic reliability and improve family counseling.